Author Archives: Helen Knight

MedRisk Launches NexGen Advantage at NWCDC

New work comp medical cost containment program delivers savings, clinical intervention and transparency.

New Orleans, La. (November 30, 2016) – MedRisk announced a new workers’ compensation cost containment service model, NexGen Advantage, at the National Workers’ Compensation & Disability Conference & Expo.

“Traditional medical cost containment program results are plateauing, yet payers are still losing between three to five million dollars in savings for every $100 million spent on medical services,” said Mary O’Donoghue, MedRisk’s Chief Product Development Officer. She noted that approximately seven percent of medical payments are improperly paid. 

NexGen Advantage is the industry’s first single solution that uses analytics and technology to identify and deliver the best combination of strategies to ensure accurate and fair medical payment of individual bills. “NexGen leverages the buying power of a mega network with more than 900,000 providers, an incredibly powerful data analytics system, and expert clinical intervention to capture additional savings after bill review, make payers’ lives easier, and improve provider partnerships,” O’Donoghue added.

NexGen Advantage runs a payer’s bill data through a sophisticated analytic that examines a number of factors, including jurisdiction, bill type, facility, and provider type. There is a single, flat access fee. Taking each payer’s business objectives into account, the program determines where a preferred provider organization is most effective and where other cost containment strategies are best for all parties.

Online access to data and peer-to-peer conversations with providers about benchmarking, coding and payments help to reduce provider confusion.

“NexGen Advantage supports a partnership between payers and providers by delivering full transparency for fair and appropriate payment, “O’Donoghue said. “This is particularly important as the industry looks toward building stronger, outcomes-oriented networks.”

About MedRisk
MedRisk is the leader in physical rehabilitation and diagnostic imaging solutions for the workers’ compensation industry. Founded in 1994 and based in King of Prussia, Pa., MedRisk is accredited under URAC for utilization management and has successfully completed a SSAE 16 Type II examination. MedRisk’s programs deliver savings and operational efficiencies that are significantly greater than traditional programs. Customers include insurance carriers, self-insured employers, third-party administrators, state funds, and case management companies.

To make a referral or obtain more information, visit www.medrisknet.com or call 800-225-9675.

 

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Media Contacts: 
Helen Patterson, King Knight Communications, helen@kingknight.com, 813-690-4787

Rommy Blum, MedRisk, Inc., 800-225-9675 ext. 1150; rblum@medrisknet.com

 

 

Dan Anders Joins Tower MSA Partners as Chief Compliance Officer

Delray Beach, Fla. (November 30, 2016) — Tower MSA Partners, which provides Medicare Secondary Compliance services and Medicare Set-Asides in workers’ compensation and liability, has selected Dan Anders as Chief Compliance Officer.  This is a new, senior management position that oversees all aspects of regulatory compliance associated with the Medicare Secondary Payer Statute and local, state and federal laws.

“Dan’s vast experience in MSP compliance and his ability to navigate the complex legal issues associated with MSAs and conditional payments make him a perfect candidate to lead Tower’s legal and compliance team.   We are delighted to have someone of his expertise to drive future growth,” said CEO Rita Wilson.

An attorney and a certified Medicare Set-Aside Consultant, Anders brings more than 13 years’ experience in MSP compliance and MSAs to this role. Most recently, he was the senior vice president of MSP Compliance for ExamWorks Clinical Solutions, and previously he served for five years as compliance director for MedAllocators, which was acquired by ExamWorks in 2014.

Anders started his career as an attorney with Wiedner & McAuliffe in Chicago, Illinois, where his responsibilities included developing policies for handling Medicare requirements in workers’ compensation cases and preparing and submitting MSAs to CMS. He has presented at industry conferences and written a number of articles and blog posts on compliance issues.

Anders earned his Juris Doctor degree from Chicago-Kent College of Law in Chicago and his bachelor’s degree from Loyola University also in Chicago.  He is a member of the National Alliance of Medicare Set-Aside Professionals and the Illinois State Bar Association. 

About Tower MSA Partners

Headquartered in Delray Beach, Fla., Tower MSA Partners’ services include pre-MSA Triage, MSAs, physician peer reviews, CMS submissions, MSA administration, medical cost projections, life care plans, conditional payments, and Section 111 reporting. With more than 50 years combined experience in pharmacy, legal oversight and medical care, Tower proactively stages claims, working collaboratively with clients to identify issues and intervene to modify outcomes.  Tower remains involved in the claims, through final resolution, MSA and/or other settlement. This model enables Tower’s clients to provide better care to injured workers, reduce claim and MSA costs, and obtain CMS acceptance of the MSA. For more information, visit www.towermsa.com and www.mspcomplianceblog.com

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Business Wire version w/photo: Dan Anders Joins Tower MSA Partners as Chief Compliance Officer

Request photo from helen@kingknight.com

 

Media Contact:  Helen Patterson, King Knight Communications, 813-690-4787; helen@kingknight.com

 

Workers’ Comp Drug Spend is Down, according to CompPharma’s 13th Annual Survey of Prescription Drug Management

Survey shows 8.7 percent reduction in worker’s compensation payers’ drug spend

Maggie Valley, North Carolina (November 1, 2016) – CompPharma’s 13th Annual Survey of Prescription Drug Management in Workers’ Compensation showed an 8.7 percent reduction in payers’ pharmacy spend. The survey analyzed the 2015 pharmacy cost data of 30 workers’ compensation insurance carriers, third-party administrators, self-insured employers, and state funds. 

Payers credited tighter clinical management, better integration with their pharmacy benefit managers, and prescriber interventions for the decrease.  All have opioid management programs to limit the number of initial opioid prescriptions and/or decrease morphine equivalents across as many claims as medically appropriate.  

“Twenty percent of the respondents also had assertive settlement initiatives and have been closing older claims,” said Joseph Paduda, president of CompPharma, LLC.  “Overall, payers have seen drug costs go down by 11 percent in the past six years despite the 2014 increase.”

Opioids remained the number-one payer concern with compounds ranking as the main emerging issue. 

PBM consolidations received mixed reactions from the payer community.  Some respondents hoped mergers would bring better pricing and more clinical capabilities while others expressed concern that the lack of competition would breed complacency. 

“There is a sense of acceptance along with a little wariness about potential customer service issues,” Paduda said.  “Consolidation in other segments of the industry has spawned customer service problems when people-based operating models were replaced with offshored or tech-enabled models.”

A complimentary copy of the 2016 survey can be downloaded from www.comppharma.com.

About CompPharma

Established by industry consultants Joseph Paduda and Helen King Patterson, CompPharma, LLC is a consortium of workers’ compensation PBMs active in workers compensation.  More information is available at www.comppharma.com or by contacting Patterson at 813-690-4787 or hpatterson@comppharma.com.

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Media Contact:  Helen Patterson, 813-690-4787; hpatterson@comppharma.com

Restore Rehabilitation Announces More Growth

Workers’ compensation nurse case management company now provides services in Mississippi

Owings Mills, Md. (October 11, 2016) — Restore Rehabilitation, a medical and vocational case management company focused on reducing the cost of workers’ compensation claims through high quality medical treatment, recently introduced field case management services into the state of Mississippi.

Restore’s field case managers maintain advanced credentials and have at least three years of experience in workers’ compensation. Most often used on complex cases involving multiple body parts, amputations, severe burns, spinal cord damage, and comorbidities, field case managers are also helpful with unwitnessed or questionable injuries.

“Mississippi represents an ideal territory for expansion based on our market penetration in the bordering states,” said Restore Rehabilitation President and CEO Pam Anthony.  “There are approximately three million people residing in Mississippi, and Restore is confident in our ability to have a positive impact on the state’s workers’ compensation needs.”

Field case managers evaluate injured employees’ treatment plans to assist them in navigating the complicated workers’ compensation maze. They help identify high quality medical providers and potential return to work hurdles, while helping injured employees achieve maximum medical improvement and full return-to-work status.

“In response to the market’s need for a national boutique case management firm, Restore welcomes the opportunity to expand our geographic footprint,” Anthony added. “Restore continues to hire high caliber talent and is currently seeking experienced case managers in Colorado, Massachusetts, Maryland, Tennessee, Texas, Virginia, and Washington, D.C.”

About Restore Rehabilitation

Celebrating its 10th anniversary, Restore Rehabilitation offers an early intervention program, bilingual services, catastrophic case management, life care planning, file reviews, and medical cost allocations. In addition to providing telephonic case management in all 50 states, Restore now delivers field case management services in: Alabama, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Illinois, Maryland, Massachusetts, Mississippi, New Hampshire, New Jersey, New York, North Carolina, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Vermont, Virginia, and Washington, D.C. Based in Owings Mills, Maryland, Restore Rehabilitation can be reached at 866-581-8771 or www.restorerehab.biz

 

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Link to release on Business Wire Restore Rehabilitation Announces More Growth

Contact:  Helen Patterson, King Knight Communications, 813-690-4787; helen@kingknight.com

Windham Group Selects David D. Heffner as Chief Sales Officer

Heffner brings 20 years of workers’ compensation managed care experience to the position

Manchester, NH (November 15, 2016) — Windham Group, a leading case management company focused on the return-to-work continuum, has named David D. Heffner Chief Sales Officer.  Heffner is responsible for national sales, growing and mentoring the company’s salesforce and expanding strategic workers’ compensation carrier and third-party administrator relationships.

“We are excited about having Dave on board,” said Sebastian Grasso, president and CEO of Windham Group. “His background in work comp managed care and his energetic approach make him an asset to our management team.”

Heffner brought 20 years’ of sales and marketing experience for workers’ compensation managed care companies to the position.  Most recently he served as senior vice president of One Call Care Management’s Specialty Network Division. Prior to One Call, he was the executive vice president of sales and marketing for Express Dental Services and played a strategic role in Express’ acquisition by One Call. Heffner is also the former eastern region vice president of sales for MSC (Medical Services Company).

About Windham Group

Founded in 1989 and based in Manchester, New Hampshire, Windham Group provides case management services designed to facilitate return to work. Specialists analyze the injured worker’s workplace and recommend low cost, no cost changes to the work environment, enabling employees to return to work for their original employers in their pre-injury positions. The company also provides telephonic, field and vocational case management services.  For more information, please see www.windhamgroup.com or call 800-898-0386.

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Media Contact:  Helen King Patterson, APR, King Knight Communications, 813-690-4787; helen@kingknight.com

Link to release & photo on Business Wire: Windham Group Selects David D. Heffner as Chief Sales Officer

Photo available via BusinessWire or contact helen@kingknight.com.

 

MedRisk’s white paper on preventing diagnostic imaging errors

Error rates in diagnostic imaging can be as high as 30 percent. Often a busy primary care physician will order a CT when an MRI is needed or request an exam of the wrong body part or site. Sometimes imaging centers run tests on the wrong patient, a mistake that occurs just by calling a patient out of the waiting room by the first name only.

MedRisk – known for making sure that injured workers receive the right treatment from the right provider at the right time – identifies typical errors and recommends ways to avoid them in this whitepaper.